by Janice Lloyd, USA TODAY

by Janice Lloyd, USA TODAY

A new study about nursing home evacuations during hurricanes exposes grave consequences suffered by the most vulnerable residents and flaws within government guidelines for the relocations.

A 218% increase in the mortality of residents with severe dementia is cited in a three-year study of 21,255 residents living in nursing homes along the Gulf Coast within 30 days of an evacuation, and a 158% increase in deaths within 90 days. The authors' report Thursday at the Gerontological Society of America's annual meeting in San Diego comes seven months after a government study cited "gaps'' in the evacuation plans of nursing homes that could compromise health and safety.

"We don't know why these deaths are occurring after evacuations,'' says Lisa Brown, a lead author of the dementia study and a professor of aging studies at the University of South Florida-Tampa. "This is the first report to quantify the deaths. It tells us we need to think through evacuations."

Though physical safety is emphasized in government guidelines, Brown says, "there's a shortfall when it comes to mental health issues. Dementia, depression and anxiety are not being dealt with."

The authors wrote that 50% to 70% of about 1.6 million adults living in nursing homes have Alzheimer's disease or a related dementia.

"Sheltering in place'' is the preferred method for dealing with residents, Brown says, because of the risks of relocation. There was a four-fold spike in evacuations from Hurricane Katrina in 2005, when about 140 patients drowned in nursing homes, through Hurricane Gustav in 2008.

Medicare- and Medicaid-certified nursing homes are required to have written emergency plans and provide employees with emergency preparedness training. A report in April from the Office of Inspector General of Health and Human Services cited various problems with preparedness plans for "sheltering in place'' and evacuations. For example, all 24 facilities sampled did not specify "the amount of water needed to ensure sufficient supply for at least a week."

Emergency plans lacked relevant information, including only "about half of the tasks'' on a checklist of 70, the report states.

Collaboration is essential to successful evacuations, says Larry Abrams, director of the Workmen's Circle Multicare Center in the Bronx. Abrams says that during the recent evacuation of Sea Crest Health Care Center, a Brooklyn nursing home, his center scrambled to accommodate 99 patients when other facilities rejected them.

"Some of them hadn't eaten since morning or had anything to drink,'' Abrams says. "They'd been on a bus for hours. They were tired. Of course, we would find spots for them, but it was incredibly stressful on us."

Staff and residents are less resilient during back-to-back disasters, Brown says. After Hurricane Sandy, gas leaks and fires followed; then a nor'easter hit.

"This cascading of disasters is more commonplace,'' she says. "There needs to be research on how to protect everyone's mental health during those times."